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Human Resources, Risk Management Division, recommending the Board consider the following:
1) Approve Amendment No. 4 to Prescription Benefit Services Agreement 196-S0811 between Caremark, L.L.C. and County of El Dorado to include an enhanced prescription drug utilization management program, effective July 1, 2010; and
2) Authorize the Human Resources Director to execute the amendment and necessary attachments and forms to implement the utilization management prescription program.
FUNDING: Risk Management Internal Service Fund
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Fiscal Impact/Change to Net County Cost:
No Change to Net County Cost. The prescription drug benefit program is budgeted in the Risk Management Internal Service Fund. Costs of this program is included in the published health rates approved by the Board on April 27, 2010 for FY 10-11. The additional services provided by Amendment No. 4 are estimated not to exceed $ 26,000 for the 2010-11 fiscal year.
Background and Reason for Recommendation:
The Enhanced Utilization Management (UM) program was presented to and approved by the Health Plan Advisory Committee. The UM program will define a prescription review and appeal process to improve participants' pharmaceutical care and dosing regimens. With a prescriber’s approval, the program may involve a change in the duration of a particular drug therapy, the drug prescribed, the dosage, or the use of a generic or preferred brand name medication, which will provide improved pharmaceutical care to the plan participant and control costs to the program as a whole.
Additional strategies to control program costs include prior authorizations, quantity limits, and enhanced safety and monitoring for certain controlled substances and sleep agents .
Action to be taken following Board approval:
Following Board approval: Human Resources, Risk Management Division will sign the amendment and necessary attachments to be effective July 1, 2010.
Contact: Janet Parnell, x 6225
Concurrenc...
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